Abstract

AR Bansal, Rathindra Tripura, Rajesh Godara* and Jaikaran

Aims and Objectives: To prospectively evaluate and compare effectiveness of topical 0.2% glyceryl trinitrate ointment vs lateral internal sphincterotomy in treatment of patients with chronic anal fissure. Material and Methods: The study included a total of 50 patients presented with chronic anal fissure, divided into two groups by computer generated randomization. Group A included 25 patients with chronic anal fissure treated with local glyceryl trinitrate ointment 0.2% whereas Group B included 25 patients managed by lateral internal sphincterotomy.

Results: The mean age of patients in group A was 34.6±12.8 years and in Group B was 32.12±11.57 years (p>.05). In group A, out of 25 patients, 19 were male and 6 females, whereas in group B, there were 20 males and 5 females. The mean pain score of patients before treatment in group A was 8.64±0.95 where as in group B was 8.44±1.19. At the end of six weeks of treatment the mean pain score was 1.64±2.43 in group A and 0.24±1.20 in group B respectively. Complete healing was observed in 18 out of 25 (72%) patients in group A whereas all 25 (100%) patients in group B had completely healed fissures at the end of six weeks. Except headache which was reported in 9 out of 25 (36%) patients in group A no other side effect was seen in this group. Whereas only 1 out of 25(4%) patients in group B developed haematoma in the perianal area, which was relieved conservatively within 1 week.

Conclusion: Glyceryl trinitrate ointment is a good alternative mode of therapy, hence lateral internal sphincterotomy may be reserved for patients who fail to respond to initial glyceryl trinitrate therapy.